![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 13 of 13. This is the beginning of the thread.
Posted by Harvester of Eyes on November 7, 2003, at 18:49:30
I have tried to help a few members in the past. Now I could use an assist.
Average dose of Lithium with moderate Lamictal. Ten days ago cut Klonepin (for sleep) from 2 mg to 1 mg and started diet with goal to lose ten pounds.
Problem: Sudden escalation in tremors, facial twitches and spasms, especially when falling asleep. Also increased vertigo when bending.
I haven't had a blood draw for several months. I will get one Monday.
It is Friday night and I am in regular mood but twitchy and shaky and of course concerned by the sudden increase. I am aware of the need to maintain water and salt intake. I would say the problem started slowly two weeks ago, rose gradually, and jumped sharply today.
Any advice?
Should I cut my dose a tiny bit in case blood levels are high? I have people here to keep an eye on me in case of a negative trend.
Posted by john b stevens on November 7, 2003, at 20:34:26
In reply to Lithium Experts -- Please Advise, posted by Harvester of Eyes on November 7, 2003, at 18:49:30
People with lithium toxicity usually feel sick and look sick; often compared to flu-like symptoms (nauseau, vomiting, diarrhea). You don't sound quite like this. That said, your level could be a tad high; maybe not. If you cut down on your dose for a couple of days (halve it, say) not much is going to happen vis a vis your psych symtpoms.
The best plan would be to call whomever manages your meds or their backup...is that an option?
Posted by john b stevens on November 7, 2003, at 20:38:46
In reply to Re: Lithium Experts -- Please Advise, posted by john b stevens on November 7, 2003, at 20:34:26
To state the obvious: make sure, if you alter your dose, to tell whomever is going to look at your level, so that they have an idea of what dosage the level reflects....
Posted by Larry Hoover on November 7, 2003, at 20:58:30
In reply to Lithium Experts -- Please Advise, posted by Harvester of Eyes on November 7, 2003, at 18:49:30
> I have tried to help a few members in the past. Now I could use an assist.
>
> Average dose of Lithium with moderate Lamictal. Ten days ago cut Klonepin (for sleep) from 2 mg to 1 mg and started diet with goal to lose ten pounds.
>
> Problem: Sudden escalation in tremors, facial twitches and spasms, especially when falling asleep. Also increased vertigo when bending.
>
> I haven't had a blood draw for several months. I will get one Monday.
>
> It is Friday night and I am in regular mood but twitchy and shaky and of course concerned by the sudden increase. I am aware of the need to maintain water and salt intake. I would say the problem started slowly two weeks ago, rose gradually, and jumped sharply today.
>
> Any advice?
>
> Should I cut my dose a tiny bit in case blood levels are high? I have people here to keep an eye on me in case of a negative trend.I'm somewhat surprised you're blaming these symptoms on lithium, while they arose just as you cut your clonazepam dose.
Your symptoms are consistent with clonazepam withdrawal.
see:
http://www.benzo.org.uk/manual/bzcha03.htm#15
Posted by john b stevens on November 7, 2003, at 21:33:27
In reply to Re: Lithium Experts -- Please Advise » Harvester of Eyes, posted by Larry Hoover on November 7, 2003, at 20:58:30
I did also think some of the symptoms could be explained by Klonopin, but you said your symptoms started two weeks ago and you cut back on your Klonopin 10 days ago. Also, slowing down on the Klonopin wouldn't necessarily explain why you had a 'sudden jump' in symptoms over the last two days; although, your body could be feeling the final, tail end days of that extra 1mg finally saying bye bye.
Posted by Harvester of Eyes on November 8, 2003, at 11:49:57
In reply to Re: Lithium Experts -- Please Advise » Harvester of Eyes, posted by Larry Hoover on November 7, 2003, at 20:58:30
This is why it often takes an outsider to see in.
Your comment about benzo withdrawal is compelling. The link strongly endorses your idea. Thank you.
Posted by Harvester of Eyes on November 8, 2003, at 11:53:19
In reply to Re: Lithium Experts -- Please Advise, posted by john b stevens on November 7, 2003, at 21:33:27
I wanted to give a complete picture and did not give precise numbers of days because I simply don't remember to the day. Your points are very good and helpful. Thank you.
Posted by Harvester of Eyes on November 8, 2003, at 12:28:51
In reply to Re: Lithium Experts -- Please Advise » Harvester of Eyes, posted by Larry Hoover on November 7, 2003, at 20:58:30
Your insight raises a question. Your personal feelings, please, on this:
Which would be a better way to reduce clonozepam withdrawl symptoms when they become debilitating?
- reduce rate of withdrawal
- use Lorazepam lightly and sporadically when symptoms are worstBoth of you who responded have been a big help. I send you good kharma.
Posted by Larry Hoover on November 8, 2003, at 15:01:01
In reply to Re: Lithium Experts -- Please Advise, posted by Harvester of Eyes on November 8, 2003, at 12:28:51
> Your insight raises a question. Your personal feelings, please, on this:
>
> Which would be a better way to reduce clonozepam withdrawl symptoms when they become debilitating?
>
> - reduce rate of withdrawal
> - use Lorazepam lightly and sporadically when symptoms are worst
>
> Both of you who responded have been a big help. I send you good kharma.My humble opinion is that both methods should be employed. Dropping your clonazepem dose by half in one fell swoop seems to a greater rate than your body can tolerate. I know it will be difficult to get fractional doses, but one method that I've heard of is to break pills in half....but of course they'll come out less than perfectly divided. So, you break a bunch of them in half, then eyeball them into a biggest to smallest range of sizes. That way you can guesstimate your taper dose. If clonazepam is available as a liquid formula, the whole thing becomes dramatically easier, as volume is proportional to dose, but I don't think it is. Klonopin does come in scored 0.5 and 1 mg sizes, so that might allow for some creative dosing control.
Lar
Posted by pseudonym on November 8, 2003, at 17:10:40
In reply to Re: clonazepam taper » Harvester of Eyes, posted by Larry Hoover on November 8, 2003, at 15:01:01
The way to taper off of clonazepam is with Keppra, aka levetiracetam. I went off of 1.5 mg Klonopin per day in about a week's time. I would use approximately 1000mg of Keppra in the morning and 1000mg at night. I have tapered off clonazepam without it, which was horrific. With Keppra, I almost didn't notice it. Keppra, if you care, is a relatively new anti-epileptic drug.
Posted by Harvester of Eyes on November 8, 2003, at 22:09:50
In reply to Re: clonazepam taper, posted by pseudonym on November 8, 2003, at 17:10:40
Is Keppra something you just take while tapering the clon.?
I will read up on it.
Posted by Harvester of Eyes on November 8, 2003, at 22:18:15
In reply to Re: clonazepam taper » Harvester of Eyes, posted by Larry Hoover on November 8, 2003, at 15:01:01
Thanks, Lar, for the opinion. I can titrate the dose, like you suggested, no problem.
I have moved up and down on clonozepam before without noticing anything. I always took care to minimize my reliance on it, and took breaks from it with occasional reliance on lorazepam. This time it snuck up on me, as drugs are known to do.
The unpleasantness is reduced 50% now that I am confident about the cause and have ideas for action against the shaking. Soon I'll be able to eat soup again without the dog lapping up the spray from around my chair.
Thanks again. It sure was nice to be able to come here for help when I needed it.
Posted by Elle2021 on November 10, 2003, at 6:18:02
In reply to Lithium Experts -- Please Advise, posted by Harvester of Eyes on November 7, 2003, at 18:49:30
I have been on and off Klonopin too. When I am trying to get off of it, I use Ativan (Lorazepam) to keep the withdrawl symptoms to a minimum. It worked for me.
Elle
This is the end of the thread.
Psycho-Babble Medication | Extras | FAQ
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.org
Script revised: February 4, 2008
URL: http://www.dr-bob.org/cgi-bin/pb/mget.pl
Copyright 2006-17 Robert Hsiung.
Owned and operated by Dr. Bob LLC and not the University of Chicago.